Provider Demographics
NPI:1528205945
Name:CARBONE, DONA D (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONA
Middle Name:D
Last Name:CARBONE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:EASTPOINT
Mailing Address - State:FL
Mailing Address - Zip Code:32328-0973
Mailing Address - Country:US
Mailing Address - Phone:850-927-5019
Mailing Address - Fax:
Practice Address - Street 1:1304 AZALEA DRIVE
Practice Address - Street 2:
Practice Address - City:ST. GEORGE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32328-0973
Practice Address - Country:US
Practice Address - Phone:850-927-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPRV-9007-R/XX/001010Medicaid